Project Summary Stroke is a leading cause of long-term disability, reducing everyday mobility and communication skills in more than half of survivors. Acute rehabilitation through early interventions is a mainstay for recovery and improving physical function in stroke patients. Unfortunately, patients recovering from acute stroke are at risk for poor, non-restorative sleep, when sleep is critical for recovery and participation in intense physical rehabilitation. During acute rehabilitation, stroke patients face two sleep-related challenges: (1) uncoordinated and often unnecessary nocturnal interruptions (vitals, medications, etc.) due to medical or nursing care; and (2) a high risk of undiagnosed sleep disordered breathing. Given the critical role of sleep in enhancing neural recovery, motor learning, neuroprotection, and neuroplasticity, interventions to enhance sleep that target these two areas could improve recovery and rehabilitation outcomes for stroke patients. In this proposal, a multidisciplinary group of researchers with expertise in rehabilitation medicine, sleep medicine, nursing, physical therapy, wearable technologies, and implementation science will adapt, implement and evaluate a state-of-the-art intervention to promote sleep for stroke patients undergoing acute rehabilitation. SIESTA-Rehab, adapted from our previous unit-based intervention, bundles two sleep-promoting interventions to address the unique sleep challenges stroke patients face during acute rehabilitation: (1) nursing education and empowerment to reduce unnecessary disruptions; (2) a systematic protocol to screen, diagnose, and treat sleep-disordered breathing if present during acute stroke rehabilitation. This work will take place at the Shirley Ryan Ability Lab (SRALab), the first-ever translational research hospital that brings clinicians and researchers together to make breakthrough discoveries in rehabilitation. Researchers at their Center for Bionic Medicine have pioneered the development and validation of a high-resolution wearable sensor platform to monitor stroke recovery via continuous biometric and movement-based sensor data for clinical symptoms (e.g., movement, sleep, heart rate variability, speech & swallowing, and gait quality). These sensors have been tested during performance of validated clinical tests and inpatient activities (e.g., therapy, down-time, sleeping). We aim to study the effectiveness of SIESTA-Rehab on improving sleep and rehabilitation outcomes during acute rehabilitation for stroke and after discharge home. Because there are two stroke floors at SRALab and patients are admitted in a quasi-random allocation, we can implement SIESTA-Rehab in one unit while the other unit receives Usual Care (routine night nursing care and clinician judgment to order sleep study). This natural experiment enables a difference-in-differences approach, controlling for relevant covariates, to compare short and long-term sleep and rehabilitation outcomes between patients in the SIESTA-Rehab and Usual Care units.